Register to be a Member:

You can register with your check or money order (in USD), and mail it, along with this form, to HPTH Association Inc., P.O. Box 2258, Idaho Falls, ID 83403.

Step 1: Fill out Your Info Below and hit Submit

Step 2: Choose Your Membership Type (After registration make sure to update your Medical Information after you register and log into the site)

• - 1 yr........ $25.00
• - 2 yr........ $45.00
• - Lifetime.... $210.00

Member Info:

Please select the type of member that best describes you:			Patient Parent of Patient Physician Nurse Friend Relative Just Interested Business Information Resource Health Care, misc Other Contributor/Sponsor Pharmacist Pet Owner *
First Name:	*	Last Name:	*
Company Name:		Email:
Home Phone:	*	Work Phone:		Mobile Phone:

Mailing Address:

Street Address:	*	City:	*
State:	*	Zip:	*	Country:

Account Preferences:

Share my contact info with other HPTH members
Subscribe to HPTH email notifications
Preferred Language:	English Spanish Portuguese German Hebrew French Italian Dutch
Password:	*	Confirm Password:	*

To Register fore a Conference:

You can register by check or money order (in USD), you can mail it along with form below to: HPTH Association Inc., P.O. Box 2258, Idaho Falls, ID 83403.

Step 1: Fill out Your Info Below and hit Submit

Step 2: Pay for your conference or Banquet.

Registration Date:

Date:
I am already a paid:	No Membership 1 year membership (subtract $10.00 from Conf. fee) 2 year membership (subtract $10.00 from Conf. fee) Lifetime membership (subtract $15.00 from Conf. fee)		(subtract from Conference Fee accordingly)

Registration Information:

Name:		Phone:		Email:
Street Address:
City:		State:		Zip:

Attendee Information:

Conference (# of attendees):			$75.00 Per Person
Banquet (# of attendees):			$25.00 Per Person
Names of People Attending:

Payment Information:

- Before April 1st - subtract $10.00 from Conf. fee for each person attending. - After April 1st but before May 1st - subtract $5 Conf fee for each person attending. - After May 1st - no discount. All discounts will be calculated based on the postmark of the registration.

I will be sending a check/money order for: (in USD)

No refunds will be given. In the event you have to cancel, your conference and banquet fees will converted to a tax-deductible donation.